Conclusions

Results of the DCCT and UKPDS suggest that if intensive glycemic control can be achieved, there will be a reduction in the progression of both diabetic retinopathy and nephropathy. Epidemiological data and some clinical trial data suggest that blood pressure control might also be an effective approach to reducing both complications. There are some recent findings suggesting that inflammation, oxidative stress and coagulability may also have an affect on both complications. Both retinopathy and nephropathy are linked together as "microvascular" in origin and share similar risk factors. However, after long duration of disease, most individuals will develop retinopathy but about two-thirds will develop clinical signs of nephropathy. This suggests possible genetic differences making susceptibility to damage of each system different for a given level of exposure of blood pressure, glycemia, and other risk factors. Identification of genetic polymorphisms associated with risk for one or both complications may lead to newer preventive treatments in diabetic persons at risk of developing the earlier preclinical stages of the disease.